What’s safe, what’s not, and when to get your OB involved.
Some pregnant people worry that taking medication could harm their baby, leading to tough choices and unnecessary stress. But you don’t have to choose between your health and your baby’s.
“A lot of medications are safe in pregnancy,” says Stacy Sun, MD, MPH, FACOG, an OB/GYN at UR Medicine. “There are definitely medications that are not. The key is knowing which is which, and talking to your provider before you stop or start anything.”
Even for medications that aren’t safe during pregnancy, there often are good alternatives. Here’s what to know.
Not All Medications Are Created Equal
Some medications are generally safe when taken as directed. Others should be avoided. Many fall into a middle category and require a conversation with your provider.
Safe During Pregnancy (When Used as Directed)
- Acetaminophen (Tylenol) for pain or fever (Dr. Sun recommends no more than 1,000 mg every six hours.)
- Allergy medications, including Benadryl, Claritin, and Zyrtec
- Prenatal vitamins
- Antacids such as Tums and Pepcid
Avoid During Pregnancy
- Ibuprofen and other NSAIDs, as they can cause cardiac issues in babies
- Nighttime or ‘PM’ cold medications that contain alcohol
May Use with Close Supervision
- Narcotics and prescription muscle relaxants, such as Flexeril
“If people need it, people need it,” Dr. Sun says. “It’s not always a no—it’s a discussion.”
Why the Answer Is Often “It Depends”
Pregnancy care is personal. What’s right for one person may not be right for another.
Someone with celiac disease, for example, may need help maintaining healthy iron levels. A patient with schizophrenia may need ongoing medication to protect both their own health and their baby’s.
“Each person brings so many different issues to the table,” Dr. Sun says. “That’s the whole point of our field—to consider the individual.”
When a pregnancy is medically complex, Maternal–Fetal Medicine (MFM) specialists provide a higher level of care, working closely with OB/GYNs to support shared decision-making for both parent and baby.
Sick While Pregnant: What to Take and When to Call
Illnesses can hit harder during pregnancy.
“Your body is already a bit immunosuppressed,” Dr. Sun explains, “so recovery can take longer than it would otherwise.”
For Colds and Flu-Like Symptoms
If you think you might have the flu or COVID-19, call your provider and get tested. They may offer treatment to help shorten recovery and limit symptoms.
If you have a cold, consider:
- Guaifenesin (the active ingredient in Robitussin) is safe
- Nasal decongestants are generally safe
- Avoid PM formulations that contain alcohol
Fever Matters During Pregnancy
The most important symptom to watch for is fever. High fevers during pregnancy have been linked with neural tube defects, which is why early guidance and aggressive fever control are important.
If you are pregnant and have a fever:
- Take acetaminophen (Tylenol), as directed
- Call your provider if:
- A fever doesn’t improve within 48–72 hours
- A fever climbs toward 104°F
- Do not take an ice bath, as these are not effective at lowering intrauterine temperature
Heartburn is common during pregnancy, and a healthcare provider can help identify safe treatment options.
Heartburn During Pregnancy
Heartburn is a common symptom during pregnancy. Dr. Sun recommends starting with Tums, then adding Pepcid if symptoms persist. If heartburn doesn’t improve, contact your provider. In some cases, a proton pump inhibitor (PPI), like pantoprazole may be recommended.
Continuing Medications That Keep You Well
Continuing current medications is often a critical part of a healthy pregnancy. This is especially true for those with mental health conditions and chronic illnesses, where stopping treatment suddenly can pose real risks to both parent and baby.
This is one of the most important messages we share. Do not stop your medications on your own when you find out you’re pregnant. Please reach out to a provider so we can talk it through.”
Mental Health Medications
Stopping medication suddenly can increase the risk of postpartum depression, psychosis, and suicidal thoughts.
Most SSRIs are considered relatively safe during pregnancy, such as sertraline (Zoloft) and escitalopram (Lexapro). Wellbutrin (bupropion) is also commonly prescribed and considered safe. Medications that need more careful consideration include Paroxetine (Paxil), Fluoxetine (Prozac), and mood stabilizers, such as lithium.
Regardless of the specific type, abruptly stopping psychiatric medications during pregnancy can be riskier than continuing treatment.
“If this medication’s important to you for your mental health, you should keep taking it,” Dr. Sun says. “You are the most important person in your child’s life.”
Chronic Conditions
Managing chronic illness during pregnancy is essential for both parent and baby.
- Asthma: Flonase and standard inhalers, including steroid inhalers, are safe.
- Diabetes: Insulin treatment is very safe in pregnancy.
- Hypertension and heart disease: Medications such as labetalol and nifedipine are commonly prescribed and safe. ACE inhibitors and ARBs should be avoided.
Vitamins, Supplements, and Antacids
A prenatal vitamin with folic acid is an important part of a healthy pregnancy. Starting early helps lower the risk of neural tube defects. Some patients, such as those with a history of seizures, may need a higher dose of folic acid, which should be guided by a clinician.
Iron supplements are not routinely needed for everyone. They are recommended only when anemia or iron deficiency is confirmed through lab testing.
More is not always better when it comes to vitamins. Avoid megadoses, as excessive amounts can be harmful:
- Too much vitamin D or vitamin K can cause complications
- High-dose vitamin A is known to be harmful during pregnancy
Birth Control and Pregnancy
If you became pregnant while taking birth control, or used Plan B before realizing you were pregnant, Dr. Sun offers reassurance.
“These do not cause birth defects,” she says. “Your body’s pregnancy hormones essentially overpower those medications.”
Vaccines During Pregnancy
One common misconception is that vaccines should be avoided during pregnancy. In fact, several are recommended to protect both parent and baby.
COVID, flu, Tdap, and RSV vaccines are safe in pregnancy and encouraged as part of routine prenatal care.
link